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IC PHARMACY LLC
CH090080 MARANA HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
MARANA HEALTH CENTER, INC.
Subdivision Name
Marana Health Center, Inc.
Type
HRSA-Funded Health Center
340B ID
CH090080
Entity Address
13395 N. Marana Main Street
MARANA, AZ 85653
Grant Number
H80CS00231
Participating Start Date
7/1/1999
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
IC PHARMACY LLC
Pharmacy Address
AMAZON PHARMACY #004
34 35TH STREET
STE 4BSW, UNIT 28
BROOKLYN, NY 11232
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Heidi Kurgat, Director of Compliance and Risk
(573) 578-1344
Contract Pharmacy Representative
AMAZON PHARMACY
JOHN M LAVIN, MANAGING OFFICER
(602) 793-8552
Signed By Date
7/15/2024
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